INSIGHTi
COVID-19: U.S. Public Health Data
and Reporting
Updated June 4, 2020
The daily updated counts of cases and deaths during the COVID-19 pandemic have served as important
indicators throughout the crisis—informing policy decisions, research, and public awareness. Ongoing
data collection, or surveillance, is a key component of public health practice. As the nation’s lead public
health agency, the Centers for Disease Control and Prevention (CDC) has sought to conduct surveillance
within the U.S. system of federalism where many public health authorities are based in state law. Some
observers have called for improved public health surveillance during the pandemic; this Insight provides
an overview of the current systems and policy considerations for Congress.
Overview of U.S. Public Health Surveillance
In the United States, national public health surveillance is conducted through multiple multifaceted
systems generally involving the federal, state, territorial, and local (jurisdictional) governments. Much of
the original data, such as on COVID-19 virus test results and hospitalizations, are collected from disparate
and often private organizations such as laboratories, hospitals, and outpatient health care facilities.
Jurisdictions can mandate the collection of certain data from private entities in jurisdictional law and can
implement reporting systems. These data are then used to inform jurisdiction-level public health policy
and actions. De-identified data are then usually provided voluntarily to CDC by the jurisdictions. CDC
provides funding, sets data standards, and provides technical assistance to jurisdictions for surveillance
systems. CDC may also conduct national-level public health surveillance by other means, such as through
surveys or data collected directly from health care entities or other designated sites.
Current COVID-19 Public Health Surveillance Systems
Throughout the COVID-19 epidemic, some have critiqued the adequacy of U.S. public health
surveillance. Aside from data issues related to diagnostic testing, some have critiqued the timeliness of
reporting, the availability of additional demographic information on COVID-19 cases (such as on
race/ethnicity), and the completeness of COVID-19 mortality data. These critiques point to some long-
standing issues with U.S. public health surveillance, including differences in jurisdictional laws and
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systems for surveillance, such as for electronic reporting systems and requirements for the medical
certification of deaths.
In the current COVID-19 pandemic, CDC and other federal agencies (such as the Federal Emergency
Management Agency, FEMA) are collecting many types of data to inform the federal response and to
better understand the disease and affected populations. The Department of Health and Human Services
(HHS) reportedly consolidates data internally from various sources to inform federal response.
CDC publishes a weekly surveillance report, COVIDView, with data related to COVID-19 outpatient
visits, emergency department visits, hospitalizations, deaths, and laboratory data. These data draw upon
multiple surveillance systems, including additions to the existing influenza surveillance systems, and
mortality data collected through the National Vital Statistics System. These high-level data are intended as
indicators for monitoring the pandemic.
CDC also collects more detailed data on COVID-19 cases through the National Notifiable Diseases
Surveillance System (NNDSS). In this system, jurisdictions mandate the reporting of certain notifiable
diseases from health care entities to jurisdictional health departments, and then voluntarily share de-
identified data with CDC. A notifiable disease or condition is one for which “regular, frequent, and timely
information regarding individual cases is considered necessary for the prevention and control of the
disease or condition.” CDC, with the Council of State and Territorial Epidemiologists, publishes a list of
diseases and conditions recommended to be reported by jurisdictions and supports electronic reporting
systems. COVID-19 is a reportable disease in all jurisdictions, and CDC has developed a case reporting
system. Jurisdictions can report preliminary data through the system and complete records over time as
more information is gathered and the patient situation changes.
CDC has published some preliminary research using case report data, including a report on severe
outcomes among patients (February 12-March 16, 2020) and on underlying health conditions (February
12-March 28, 2020). These reports note how reporting from jurisdictions can be preliminary and often
lacks details on cases. For example, the report on underlying health conditions stated,
the analysis was limited by missing data related to the health department reporting burden associated
with rapidly rising case counts and delays in completion of information requiring medical chart
review; these findings might change as additional data become available.
Given limitations with NNDSS, CDC also operates COVID-NET, a surveillance system that collects
detailed data on COVID-19 hospitalizations in 100 counties across the United States. Data from this
system can allow for more robust analyses on subsets of COVID-19 cases, such as published in a CDC
report.
Executive Actions and HHS Data Collection
The White House and the HHS Secretary have also taken several actions to request data from several
stakeholders, including laboratories, health care providers, and nursing homes. Vice President Michael
Pence sent a letter on March 29 to hospital and academic laboratories requesting that data on laboratory
results and patient capacity be sent daily to HHS, in addition to any jurisdictions that require reporting.
Subsequently, on April 10, HHS Secretary Alex Azar sent a letter to hospital administrators requesting
daily COVID-19 data to be submitted to HHS, in addition to any jurisdictions that require reporting. The
letter gives hospitals various options to meet these reporting requests, including through a module in
CDC’s National Healthcare Safety Network and to a new portal established by an HHS vendor,
TeleTracking. According to statements by the American Hospital Association (AHA), TeleTracking data
have been used for targeted distributions of the CARES Act Provider Relief Fund and allocations of
Remdesivir, the antiviral drug available under a U.S. Food and Drug Administration (FDA) Emergency
Use Authorization (EUA). Data from TeleTracking do not appear to be included in CDC’s online
surveillance summaries.
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Congressional Actions
Congress has taken several actions related to public health data and reporting. Section 18115 of the
CARES Act (P.L. 116-136) requires laboratories to report COVID-19 test results to the HHS Secretary, as
specified. This section repeals a provision related to laboratory reporting in the Families First Coronavirus
Response Act (P.L. 116-127, Section 1702). Congress has also appropriated funding in several
coronavirus supplemental appropriations acts for grants/cooperative agreements between CDC and
jurisdictions for public health functions, including surveillance—not less than $950 million in the first
supplemental (P.L. 116-123), not less than $1.5 billion in the CARES Act (P.L. 116-136), and not less than
$11 billion in the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA; P.L. 116-
139). In addition, the CARES Act includes $500 million to the CDC for “public health data surveillance
and analytics infrastructure modernization.” Additional funding for CDC and transfers from other HHS
accounts in these acts could also be used by the agency for surveillance purposes.
PPPHCEA also includes several provisions in Division B that require HHS reporting and analysis of data
on COVID-19 cases, hospitalizations, and deaths, including two required COVID-19 reports
“disaggregated nationally by race, ethnicity, age, sex, geographic region, and other relevant factors.” One
of these reports (for which the deadline has passed) has been made available publicly on the Senate
Health, Education, Labor, and Pensions (HELP) Committee website.
Policy Considerations
As the COVID-19 pandemic progresses, more comprehensive, location-specific, and timelier data could
help support the nation’s continued response, as well as local-level public health decisionmaking, such as
informing social distancing guidelines. At the same time, differences in policies and capabilities across
jurisdictions may not enable rapid and standardized data collection from the jurisdictions. Surges in cases
can also affect reporting capacity. CDC reports that it is working with each jurisdiction to enable complete
and timely reporting systems for COVID-19 data that will be adaptable for future health issues. Reporting
burden on health care providers may also be an issue—AHA has expressed concern about “federal data
requests duplicating those of states and other non-federal entities.” Congress may consider how to
optimize federal and jurisdictional reporting to meet various objectives of public health surveillance,
including informing emergency response decisionmaking and a better understanding of the disease and
affected populations.
Author Information
Kavya Sekar
Analyst in Health Policy
Disclaimer
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